Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, "Paolo Giaccone", Palermo, Italy.
Department of Head and Neck Surgery, Neurosurgery Unit, Garibaldi Hospital, Piazza Santa Maria di Gesù, 5, Catania, 95123, Italy.
Neurosurg Rev. 2024 Nov 4;47(1):833. doi: 10.1007/s10143-024-03062-z.
Trigeminal neuralgia (TN) is a severe chronic pain condition, typically affecting patients over 50-year-old, caused by the compression of the nerve at the root entry zone (REZ) by blood vessels. While the diagnosis is clinical, advanced imaging like diffusion tensor imaging (DTI) is crucial to identify underlying causes and assessing nerve damage. DTI may help develop neuroimaging markers to improve understanding of TN and predict surgical outcomes. The goal of the present systematic review is to evaluate the effectiveness of DTI and tractography in order to better assess treatment planning and outcome prediction through the analysis of trigeminal nerve alterations.
The authors conducted a systematic review and meta-analysis of the literature to compare radiological parameters identified in pre- and post-operative MRI with DTI sequences, including fractional anisotropy (FA), quantity of anisotropy (QA), radial diffusivity (RD), and to correlate these findings with post-operative clinical outcomes. A comprehensive search of the PubMed and Scopus databases was carried out for studies published between April 2010 and January 2024.
This review included 11 studies and 603 patients. Of the 363 patients with trigeminal neuralgia (TN), 193 underwent microvascular decompression (MVD), with 72.5% showing clinical improvement and 27.5% not improving, possibly due to chronic nerve damage. Four studies assessed radiological parameters before and after MVD, while two focused only on post-MVD data. The mean fractional anisotropy (FA) in affected nerves increased from 0.328 before MVD to 0.382 afterward. Five studies did not report postoperative outcomes, just comparing radiological parameters in TN patients versus healthy controls.
Recent studies show that MRI-DTI parameters, including FA, RD, and QA, are useful for diagnosing trigeminal neuralgia and predicting treatment outcomes. Lower FA and higher RD values indicate better results after surgery. More research is mandatory to guide treatment decisions and enhance patients' care.
三叉神经痛（TN）是一种严重的慢性疼痛疾病，通常影响 50 岁以上的患者，由血管压迫神经根入口区（REZ）处的神经引起。尽管诊断是基于临床症状，但像弥散张量成像（DTI）这样的高级影像学检查对于确定潜在原因和评估神经损伤至关重要。DTI 可能有助于开发神经影像学标志物，以提高对 TN 的理解并预测手术结果。本系统评价的目的是评估 DTI 和轨迹分析在通过分析三叉神经改变来更好地评估治疗计划和结果预测方面的有效性。
作者对文献进行了系统评价和荟萃分析，以比较术前和术后 MRI 与 DTI 序列中发现的放射学参数，包括各向异性分数（FA）、各向异性数量（QA）、径向扩散系数（RD），并将这些发现与术后临床结果相关联。对 2010 年 4 月至 2024 年 1 月期间发表的研究进行了 PubMed 和 Scopus 数据库的全面检索。
本综述纳入了 11 项研究和 603 名患者。在 363 名患有三叉神经痛（TN）的患者中，193 名接受了微血管减压术（MVD），其中 72.5%的患者临床症状改善，27.5%的患者无改善，可能是由于慢性神经损伤。四项研究评估了 MVD 前后的放射学参数，而两项研究仅关注 MVD 后的数据。受影响神经的平均 FA 值从 MVD 前的 0.328 增加到 MVD 后的 0.382。五项研究未报告术后结果，只是比较了 TN 患者与健康对照组的放射学参数。
最近的研究表明，MRI-DTI 参数，包括 FA、RD 和 QA，可用于诊断三叉神经痛和预测治疗结果。较低的 FA 值和较高的 RD 值表明手术后结果更好。需要更多的研究来指导治疗决策并改善患者的护理。
